Key result
Among patients undergoing colorectal surgery in an ERAS program, robotic surgery was associated with a lower risk of acute kidney injury compared to open surgery (OR 0.15; 95% CI 0.06-0.39; P<0.001).
Why the study?
The prevalence, risk factors, and outcomes of acute kidney injury within an ERAS program for colorectal surgery were not well established.
What are the prevalence, risk factors, and outcomes of acute kidney injury (AKI) within an ERAS program for colorectal surgery?
Case-Control (n=555)
No
What are the prevalence, risk factors, and outcomes of acute kidney injury (AKI) within an ERAS program for colorectal surgery?
Odds Ratio: 0.15 (95% CI 0.06–0.39)
p-value: p=<0.001
Within an ERAS program for colorectal surgery, moderate to severe AKI has a low prevalence, but open surgery, longer procedures, and major complications increase AKI risk.
Low moderate-severe AKI rates support ERAS safety in colorectal surgery; leaves open causal effects versus non-ERAS care.
BACKGROUND: We aimed to determine the prevalence, risk factors, and outcomes of acute kidney injury (AKI) within an ERAS program for colorectal surgery (CRS). METHODS: This is a retrospective case-control study conducted from March 2016 to September 2018 at a single tertiary hospital in Singapore. All adult patients requiring CRS within our ERAS program were considered eligible. Exclusions were stage 5 chronic kidney disease or patients requiring a synchronous liver resection. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. Secondary outcomes included mortality, major complications, and hospital length of stay. Patient, surgical, and anaesthesia-related data were analysed to determine factors associated with AKI. RESULTS: A total of 575 patients were eligible for the study. Twenty patients were excluded from the study leaving 555 patients for analysis. Mean age was 67.8 (SD 11.4) years. Seventy-four patients met the criteria for AKI (13.4%: stage 1-11.2%, stage 2-2.0%, stage 3-0.2%). One patient required renal replacement therapy (RRT). Patients with AKI had a longer length of stay (median [IQR], 11.0 [5.0-17.0] days vs 6.0 [4.0-8.0] days; P < .001), more major complications (OR, 6.55; 95% CI, 3.00-14.35, P < .001), and a trend towards higher mortality at one year (OR, 1.44; 95% CI 0.48-4.30; p = 0.511. After multivariable regression analysis, factors associated with AKI were preoperative creatinine (OR, 1.01 per 10 µmol/l; 95% CI, 1.03-1.22; P = 0.01), robotic surgery vs open surgery (OR, 0.15; 95% CI, 0.06-0.39; P < 0.001), anaesthesia duration (OR, 1.38 per hour; 95% CI, 1.22-1.55; P < 0.001), and major complications (OR, 5.55; 95% CI, 2.63-11.70; P < 0.001). CONCLUSIONS: Within the present cohort, the implementation of an ERAS program for CRS was associated with a low prevalence of moderate to severe AKI despite a balanced intravenous fluid regimen. Patients having open surgery, longer procedures, and major complications are at increased risk of AKI.
No takes yet. Share an insight, caveat, or question.
Drakeford et al. (2021) conducted a case-control in Colorectal surgery (n=555). Robotic surgery vs. Open surgery was evaluated on Acute kidney injury (KDIGO criteria) (OR 0.15, 95% CI 0.06-0.39, p=<0.001). Among patients undergoing colorectal surgery in an ERAS program, robotic surgery was associated with a lower risk of acute kidney injury compared to open surgery (OR 0.15; 95% CI 0.06-0.39; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: